Many Colorado dialysis clinics perform better than expected by federal health measures, while a few post high rates of mortality and other complications, according to a new database.

Clinics explain the bad results as isolated years skewing averages and said a review of all renal care measures puts the poor numbers in perspective.

Patient advocates hope more consumers will use the tools in the deep database — compiled by ProPublica, a nonprofit news organization — to monitor their care and demand clear answers from health providers.

“When I dialyzed 30 years ago, there was nothing out there,” said Bobbi Wager, past president of the American Association of Kidney Patients, who is on her second successful transplant. “I know if I started my journey today, there’s all this information out there that could give me hope.”

Digging into the dialysis center data has been made easier by consumer-friendly tools created by ProPublica and its partners. Patients can compare clinics’ outcomes on death rates of patients, the number of dangerous infections they get, how often they are hospitalized, and other measures.

There are about 3,800 patients in Colorado needing dialysis to filter toxins; on average about 1 in 5 dies in any given year from serious complications of the disease, or from the illnesses that often accompany it.

At a typical clinic with 10 to 20 stations, a handful of deaths can quickly balloon mortality rates.

Two of 61 dialysis centers in Colorado reported mortality rates significantly higher than expected in the latest ProPublica update, which is based on 2011 reports by each facility.

Reliant Renal Care, a small operator out of Pennsylvania, had a mortality rate 59 percent higher than was to be expected given the illness mix of patients at its Colorado Springs location.

The complications at Reliant’s clinic included a large number of patients choosing to withdraw from treatment, as well as a high number of heart attack deaths of other patients, said Reliant registered nurse Nola McMullen.

Reliant scored well on other measures, including patients kept within targets for hemoglobin in their blood.

DaVita’s Fountain clinic was another with high mortality, with 49 percent higher death rates than expected. The clinic did better in other areas, including a low percentage of patients with less-desirable catheter access, and high success rates in fully removing wastes from blood.

DaVita’s national medical chief, Dr. Allen Nissenson, reviewed the clinic’s records and said the multi-year rate includes a spike of 14 patient deaths in 2008. In the following two years, only five and then six patients died, he said.
A number of the patients died of cardiac incidents in the hospital, and three died of malignant cancer.

The federal Medicare agency, which pays for most dialysis patients in America, did an unannounced survey of the clinic in 2009 and found no problems, he said. “It was a perfect storm of a facility operating well, with a blip influx of really sick patients that year,” Nissenson said.

DaVita had more Colorado facilities with better-than-expected mortality rates than other clinic operators, he noted.

Nissenson said he favors more disclosure, and finds the ProPublica site explains the results well for patients. Any patient using the data who finds a disturbing number should ask their doctor and the clinic’s staff for a fuller explanation, he said.

Still, Nissenson acknowledged, three other factors dominate patient decisions: where their doctor practices, which clinic is close by, and whether clinic staff have a holistic, caring approach to health.

Michael Booth was a health care & health policy writer at The Denver Post before departing in 2013. He started his journalism career as an assistant foreign editor at The Washington Post before moving with family to Denver and taking a brief stint with the Denver Business Journal. During a 25-year career at The Post, he covered city and state politics, droughts, entertainment and wrote Sunday takeouts, and was part of two Pulitzer Prize-winning teams for breaking news coverage.

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